Provider Demographics
NPI:1043992589
Name:BELTRE MEDINA, MARCEL
Entity Type:Individual
Prefix:
First Name:MARCEL
Middle Name:
Last Name:BELTRE MEDINA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4700 SCHAEFER RD
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-3655
Mailing Address - Country:US
Mailing Address - Phone:313-561-5100
Mailing Address - Fax:313-565-0309
Practice Address - Street 1:25650 OUTER DR
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-2096
Practice Address - Country:US
Practice Address - Phone:313-561-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-03
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker